PURPOSE: Standardized order sets may positively impact processes of care and outcomes. Venous thromboembolism (VTE) (deep venous thrombosis, pulmonary embolism) occurs in hospitalized patients despite increased awareness of prophylaxis needs. We evaluated the impact of standardized order sets have on drug costs, drug order clarification, and VTE incidence.
METHODS: Single tertiary care teaching center in Mississippi. Standardized order sets, including VTE prophylaxis measures and formulary drug choices, were instituted for all patients admitted to or transferred to the medical intensive care unit (MICU), and all patients admitted to the general medical services (GMED). After six months of use (2006), data were retrospectively compared to a control group in a similar six month period (2005), before order set implementation, using Fisher's exact test.
RESULTS: MICU: 474 total patients (n2005=214, n2006=260). Median drug cost per hospital stay decreased significantly from 2005 to 2006 ($604 vs. $379, p=0.013). Medication order clarification rates did not change (93 per 1000 vs. 85 per 1000, p=0.75). The incidence of VTE did not change (65 per 1000 vs. 73 per 1000, p=0.86). GMED: 1745 total patients (n2005=900, n2006=845). Medication order clarification rates decreased significantly from 2005 to 2006 (163 per 1000 vs. 96 per 1000, p=0.0001). Median drug cost per hospital stay decreased significantly ($168.24 vs. $130.80, p=0.001). The incidence of VTE did not change (46 per 1000 vs. 33 per 1000, p=0.22). Power analysis: 1200 patients in each MICU group and 800 patients in each GMED group would be required to detect a 2% VTE reduction (6.5% to 4.5%, 4.6% to 2.6%, respectively).
CONCLUSION: Standardized order sets can reduce median drug costs per hospital stay and can decrease medication order clarification rates in selected settings. A larger sample size may confirm reduction in VTE incidence.
CLINICAL IMPLICATIONS: Universal adoption of standardized order sets has the potential to significantly improve patient processes of care and outcomes.
DISCLOSURE: Michael Baumann, No Financial Disclosure Information; No Product/Research Disclosure Information